Effectiveness of a Transdiagnostic Emotion‐Focused Treatment in Clinical Care: A Sequential Single‐Case Experimental Design

Background Chronic pain frequently co‐occurs with emotional problems, highlighting the need for integrated treatment approaches. Previously, we evaluated a hybrid emotion‐focused treatment with positive results. However, there is a dire need for studies evaluating treatments in ‘real world’ clinical contexts. Therefore, this study evaluated the effectiveness of this treatment in regular clinical care. Methods Using a sequential single‐case experimental AB design with randomized baseline lengths (4, 5 or 6 weeks), pain, emotional problems and cognitive behavioural factors were assessed weekly across a 20‐week study period. Additional outcome measurements were collected at pre‐, post‐ and 12‐month follow‐up. Patients from primary and secondary care (final n = 31) with chronic pain and anxiety/depression were recruited, and their psychologists delivered the treatment. Individual effects were evaluated using non‐overlap of all pairs and aggregated effects via multilevel shift models. Acceptability, adherence and fidelity were summarized, and responders and non‐responders compared using group‐level analyses. Results Most (87%) demonstrated a treatment response on ≥ 1 outcome, and over half (55%) on ≥ 3 outcomes. One‐third were classified as broad responders. Aggregated analysis showed a significant effect on pain interference. The treatment was viewed as credible and acceptable, with greater satisfaction among responders. Non‐responders showed more variability in attendance and lower progression through later treatment phases involving exposure. Conclusion The findings support the feasibility and potential effectiveness of the hybrid emotion‐focused treatment for patients in routine clinical care. The treatment benefits most patients to some extent and a smaller subset of patients to a clinically significant extent. Significance Statement This pragmatic trial evaluates effectiveness in a clinically representative patient sample reflecting the complexity of routine care, including pain and psychiatric comorbidity, sociodemographic diversity and health care utilization. The hybrid emotion‐focused treatment represents one of several emerging approaches targeting pain–emotion connections. These findings extend results from a prior RCT and highlight the importance of evaluating interventions under real‐world clinical conditions.